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Knee Replacement

Total Knee Replacement

What is a Total Knee Replacement?

We may consider a total knee replacement under certain circumstances, but there is also an option for a partial knee replacement. This will depend on the level of pain you are experiencing and how damaged the joint is. There are also non-surgical procedures that we can undertake to manage your pain, but this depends on the level of damage and pain in the knee. Recovery from a total knee replacement can take anywhere between 6 and 12 months.

The knee combines the lower end of the femur (thighbone), the patella (kneecap) and the upper end of the tibia (shin bone). A total knee replacement is when surgery is required to replace the whole knee joint with artificial materials, such as plastic and metal. Curved polished metal is used for the femoral surface, whilst the tibia is a metal plate which is covered with high-density plastic. Similar to a hip replacement, the materials are coated with a special coating or bone cement that encourages bone ingrowth. You can find out more about knee replacements with patient resource videos.

Knee Replacement

Common Reasons for a Total Knee Replacement and What to Expect

Whilst osteoarthritis is the most common reason for this surgery, your GP or doctor may recommend a total knee replacement if you are experiencing stiffness, severe pain, inflammation, or damage to your knee joint, which may be caused by the following conditions:

  • Septic arthritis – joint infection
  • Rheumatoid arthritis – an autoimmune disease
  • Bone dysplasia – abnormal bone development
  • Osteonecrosis – disrupted blood flow
  • Aseptic necrosis (knee bone death).

Some people may experience pain day and night – common methods of maintaining the symptoms, such as medication and walking aids, don’t help relieve the pain. Others may be showing signs of advanced arthritis through X-rays and under these circumstances, we will need to consider a total knee replacement.

A knee replacement is recommended to help relieve pain and keep you mobile, however, the replacement is not a normal knee and won’t work as well as the original. The surgery offers 90-95% of patients a complete, or almost complete, pain-free life for up to 10 years. It is recommended that after you’ve recovered from your surgery (which could take up to 12 months), you do not partake in active sports or heavy labour. After 10 years, knee revision surgery may be required to replace the joint in order to ensure you maintain a pain-free and mobile life. Over time, the replacement can become loose in the socket – 5-10% of patients may need to consider revision surgery after this length of time. A second replacement surgery brings higher risks and the replacement isn’t usually as good as the first.

Knee Replacement Procedure

Knee Replacement Procedure

Before

  • Try to keep a healthy weight and exercise regularly
  • Ensure your doctor is aware of any medication you are taking
  • If you smoke, try to quit or cut down 8 weeks before the surgery
  • Book an appointment at the dentist to check for infections that may affect recovery.

Before your surgery, you will need to ensure your home is safe for your recovery:

  • Ensure you have someone available to drive you home from the hospital
  • If you are a carer for someone else, you will need to make arrangements for another carer to take your place whilst you recover
  • Ensure you have some assistance at home for household chores, such as cooking and cleaning
  • You may need help with footwear, as your knee will have limited bend after surgery
  • Cook meals in advance to freeze them, so that you don’t need to worry yourself or anyone else with cooking
  • Ensure trip hazards such as rugs, mats and cables have been removed
  • Organise your home so that you don’t have to lift and bend so much
  • For 12 weeks after your surgery, avoid flights and long journeys.

During

  • Once the anaesthetic takes effect, an incision will be made on the front of your knee and the damaged part of the knee will be removed
  • An artificial knee joint is put in place – cement or a coating will be added to help the joint bond directly to the bone
  • Stitches or clips will be used to close the skin and add a bandage to keep the wound clean.

After

Once the surgery is completed, you’ll be able to come around in the recovery room. You will be connected to a small tube which drains any excess fluid. A nurse will be available to help you. You may also be connected to an IV (drip), which provides fluids and pain relief. Once the nurse has checked your vitals, you will be transferred to your room.

Are There Any Complications to Knee Replacement Surgery?

Complications can occur after you have had your surgery, however, these only happen to a very small amount of patients. Please see below for a list of complications that can arise at various stages of surgery:

Anaesthetic complications for knee replacement

You will be given a choice of anaesthetics for your surgery which includes spinal, general or a combination of the two. With anaesthesia, there is a risk of a stroke, chest infection or heart attack. The anaesthetist will be able to discuss the options with you and decide which is suitable, depending on your circumstances.

General complications for knee replacement

  • Deep vein thrombosis – 10-20% of patients may experience this. This is when a blood clot forms in your leg. In some cases, the clot may dislodge and through the bloodstream, may travel to the lungs.
  • A blood clot reaching the lung only happens in 1-2% of patients
  • Problems passing urine – 20% of patients may experience this. If this occurs, you will be given a catheter, which will provide assistance at draining your bladder
  • Pain – this occurs after every operation. We can provide you with techniques to help manage this
  • Nausea and vomiting – this can happen to 10% of patients
  • Wound infection – if this occurs, we can give you antibiotics to treat the infection quickly
  • Changes to blood levels – this is only temporary.

Knee Replacement Surgery Complications

  • Knee stiffness – this can happen with 10% of patients
    Continuous knee pain – 5-10% of patients experience this
  • Dislocation of knee cap (patella) – this happens to 5% of patients, which can occur after 5-10 years
  • Knee joint infection – this happens in 2% of patients
  • Infections can loosen the joint and result in joint failure
  • Swelling from bleeding (Haematoma) – this occurs in only 5% of patients
  • Bruising – this is normal after the operation.
Knee Replacement Surgery

Recovery from Knee Replacement Surgery

You’ll be able to return home when your pain is manageable, you have someone to look after you (a friend or family member) and you’re able to move around safely. The wound could take between 10 and 14 days to heal and a total of up to 6 weeks to recover from surgery. It should be noted that it can take up to 12 months before you can return to your normal daily activities.

Once you’re out of surgery, you’ll be looked after by a nurse who’ll make sure your recovery is going smoothly.

In the short term, a nurse will periodically check on you to ensure that you’re okay and recovering. After the anaesthetic has worn off, you will be able to eat and drink something and you can start moving your legs.

Whilst you are lying in bed, it’s important to prevent blood clots by encouraging circulation in your legs. This can be done in a number of ways:

  • Boots that inflate with air for the first 2 days post-op
  • Support stockings, which you should wear between 4-6 weeks
  • Daily injections or tablets, which will be administered for up to 6 weeks
  • Blood thinning medication.

Walking

On the day of the operation, you’ll be shown some ways to maintain movement and strengthen the muscle around the knee. When you feel up to it, you will be able to leave the bed with the aid of a walking frame – this will prevent the joint from becoming stiff and encourage circulation.

On the day of your surgery, an X-ray will be taken to ensure the joint is in the right position. This will be accompanied by routine blood tests. Your physiotherapist can aid you with walking around if you haven’t tried it at this point.

On the second and third days after your surgery, you’ll be given some tips for washing and dressing, as well as advice on getting on and off the bed, as well as the chair and toilet. You’ll also be transferred to a walking aid and given exercises to increase your movement.

Another element of walking is taking the stairs. Once you can walk up and down the stairs safely, you’ll be able to go home. Once again, you’ll have someone to help you train to manage the stairs:

  • Always use the handrail with your walking aid in the opposite hand
  • If you’re coming down the stairs, make sure you place your walking aid on the step below before bringing your operated leg onto the step next to it
  • Move your other leg down onto the step
  • Do this the opposite way when walking up the stairs.

Home Recovery

After your operation, it’s normal to feel tired, get swelling around the joint and experience pain. It is important to get plenty of rest, whilst steadily increasing your activity, keep your leg raised and take any painkillers prescribed.

There are a number of things you can do to strengthen your knee whilst at home:

  • Ensure your wound is kept dry for at least 4-5 days after surgery and try to use waterproof dressing when showering or bathing
  • Maintain the exercises shown to you
  • Partake in some lighter activities like walking and increase how far you go gradually
  • Use your walking aid for as long as you need to
  • Make sure you have someone to help you lift heavy objects
  • You can bend your leg but make sure you don’t bend down
  • Don’t cross your legs for 6 weeks after the operation
  • Don’t twist your knee.

A knee replacement is recommended to help relieve pain and keep you mobile, however, the replacement is not a normal knee and won’t work as well as the original. The surgery offers 90-95% of patients a complete, or almost complete, pain-free life for up to 10 years. It is recommended that after you’ve recovered from your surgery (which could take up to 12 months), you do not partake in active sports or heavy labour. After 10 years, knee revision surgery may be required to replace the joint in order to ensure you maintain a pain-free and mobile life. Over time, the replacement can become loose in the socket – 5-10% of patients may need to consider revision surgery after this length of time. A second replacement surgery brings higher risks and the replacement isn’t usually as good as the first.

Driving

You may be able to start driving again around 6-8 weeks post-op, but this is only if you can control the pedals and ensure safe driving at all times. If you try to drive earlier, you may not be able to perform an emergency stop. Ensure you check with your insurance company and doctor before driving.

Working

After surgery, you’ll need time to recover and rest. However, it’s best to return to a routine as this could help you recover faster. For desk work, returning to work after 8 weeks is best. If your job is more demanding physically, we recommend waiting 12 weeks before returning to work.

Follow-Up Appointments

Stitches and staples can be removed 2 weeks after your surgery. At 6-12 weeks, you’ll need to have a check-up to ensure the joint is recovering. These can be arranged before you leave the hospital after the operation. An X-ray will be recommended to you 12 months post-op.

Why Consider a Knee Replacement with Us?

To discuss your options, you can arrange a consultation at Stoke Orthopaedic Solutions with our dedicated orthopaedic specialist and surgeon. We can make a diagnosis and treatment plan based on your medical history and further examination. During the consultation, you will also have the chance to ask any questions you may have. Book a consultation with us today.

Epidural & Spinal Anesthesia

This 3d medical animation shows epidural and epidural anaesthesia procedures.

Epidural & Spinal Anesthesia
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